The amount a doctor or hospital may bill the workers' compensation insurer for treating an injured worker is governed primarily by:

Explanation

§5307.1(a) directs the administrative director, after public hearings, to adopt and periodically revise an official medical fee schedule setting reasonable maximum fees for the treatment, care, services and goods described in §4600, with most of its structure tied to the relevant Medicare and Medi-Cal payment systems. That schedule, not the provider's own price list, caps what the workers' compensation insurer pays, which disposes of (b). (c) borrows the wrong payer: group health rates are a private contract between a plan and a provider and have no bearing on the schedule. (d) mistakes who the parties even are — the injured worker does not negotiate the medical bill, which runs between provider and claims administrator, and a disputed bill goes to independent bill review rather than to the worker. §139.6, cited here by mistake often enough to be worth naming, is the information and assistance program that publishes the guides and pamphlets injured workers receive.